Difference between revisions of "X-ray of distal radius fractures"
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|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
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===Dorsal or volar tilt=== | ===Dorsal or volar tilt=== | ||
| − | [[File:Dorsal tilt | + | [[File:Dorsal tilt.jpg|thumb|160px|Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image.]] |
| − | The dorsal or volar tilt can be described by an angle from the axial plane of the radius | + | The dorsal or volar tilt can be described by an angle from the axial plane of the radius, and goes between:<ref name="Piva NetoLhamby2011">{{cite journal|last1=Piva Neto|first1=Antonio|last2=Lhamby|first2=Fabio Colla|title=Fixação das fraturas da extremidade distal do rádio pela técnica de kapandji modificada: avaliação dos resultados radiológicos|journal=Revista Brasileira de Ortopedia|volume=46|issue=4|year=2011|pages=368–373|issn=0102-3616|doi=10.1590/S0102-36162011000400004}}</ref> |
*A line drawn between the distal ends of the articular surface of the radius. | *A line drawn between the distal ends of the articular surface of the radius. | ||
*The axial plane of radius: Represented by a line that is perpendicular to the diaphysis of the radius. | *The axial plane of radius: Represented by a line that is perpendicular to the diaphysis of the radius. | ||
| − | Sometimes, the diaphysis of the radius is hard to distinguish from the [[ulna]], and a line between them | + | Sometimes, the diaphysis of the radius is hard to distinguish from the [[ulna]], and a line between them may be used instead.<ref>{{cite web|url=https://radiopaedia.org/articles/colles-fracture|title=Colles fracture|author=Dr Paresh K Desai|accessdate=2016-12-18|website=Radiopedia}}</ref> |
Although this is the standard definition of dorsal or volar tilt, the parameter can be interpreted by clinicians as being in relation to the ''normal anatomical position'' of the articular surface of radius (which normally has a volar tilt of 11° to 12°), and should therefore be specified as shown in report. | Although this is the standard definition of dorsal or volar tilt, the parameter can be interpreted by clinicians as being in relation to the ''normal anatomical position'' of the articular surface of radius (which normally has a volar tilt of 11° to 12°), and should therefore be specified as shown in report. | ||
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===Other important features=== | ===Other important features=== | ||
Check if present or absent: | Check if present or absent: | ||
| + | <gallery> | ||
| + | File:Ulnar variance.jpg|'''Ulnar variance''': Normally between -4 mm (ulna shorter than radius) and +2 mm (ulna longer than radius).<ref name=Beumer2013>{{cite journal|last1=Beumer|first1=Annechien|last2=Adlercreutz|first2=Catharina|last3=Lindau|first3=Tommy R|title=Early prognostic factors in distal radius fractures in a younger than osteoporotic age group: a multivariate analysis of trauma radiographs|journal=BMC Musculoskeletal Disorders|volume=14|issue=1|year=2013|issn=1471-2474|doi=10.1186/1471-2474-14-170}}</ref> | ||
| + | File:Radial angulation.jpg|'''Radial inclination'''.<ref name=Beumer2013/> | ||
| + | </gallery> | ||
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| + | Radial inclination (also called ''radial angulation'') is the angle measured between:<ref>{{cite web|url=http://emedicine.medscape.com/article/398406-overview|title=Distal Radial Fracture Imaging|author=Jack A Porrino, Jr|date=2015-10-20|accessdate=2016-12-18|website=[[Medscape]]}}</ref><ref>{{cite journal|url=http://www.ijoonline.com/article.asp?issn=0019-5413;year=2016;volume=50;issue=6;spage=610;epage=615;aulast=Mishra|title=Morphometry of distal end radius in the Indian population: A radiological study|author1=Pankaj Kumar Mishra |author2=Manoj Nagar |author3=Suresh Chandra Gaur |author4=Anuj Gupta |year=2016|volume=50|issue=6|journal=Indian Journal of Orthopaedics}}</ref> | ||
| + | #A line drawn between the distal ends of the articular surface of the radius on an AP view of the wrist. | ||
| + | #A line that is perpendicular to the diaphysis of the radius. | ||
| + | Radial inclination is normally 21-25°.<ref>[https://books.google.com/books?id=q3_EthzU3dcC&pg=PA783 Page 783] in: {{cite book|title=Diagnostic Imaging for the Emergency Physician|authors=Joshua Broder|publisher=Elsevier Health Sciences|year=2011|isbn=9781437735871}}</ref> | ||
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| + | ===Other important measures=== | ||
*Displacemen in other directions | *Displacemen in other directions | ||
*Comminuted fracture, particularly if it has intra-articular involvement | *Comminuted fracture, particularly if it has intra-articular involvement | ||
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:*The degree thereof | :*The degree thereof | ||
:*That is it in comparison to the axial plane of radius (to avoid mixup with being in relation to the ''normal anatomical position'') | :*That is it in comparison to the axial plane of radius (to avoid mixup with being in relation to the ''normal anatomical position'') | ||
| − | *Other important features, if present | + | *Other abnormal important features, if present |
<P>{{Reporting}} | <P>{{Reporting}} | ||
Revision as of 12:40, 24 February 2019
Author:
Mikael Häggström [notes 1]
In projectional radiography ("X-ray") of a distal radius fracture, the most important findings are displacement and whether there is intra-articular involvement.
Contents
Quality checking
The radius should form the contour dorsally in order to better detect even undisplaced fractures.
Detection
Even if there's an initial obvious fracture, evaluate:
- Bone contours for disruptions
- Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)
In particular, also look at the scaphoid bone (see X-ray of scaphoid fractures)
In children
- Main article: X-ray of fractures in children
In patients with remaining growth plates, look for fracture involvement thereof (if present, see X-ray of fractures in children).
Displacement
Dorsal or volar tilt
File:Dorsal tilt.jpg
Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image.
The dorsal or volar tilt can be described by an angle from the axial plane of the radius, and goes between:[1]
- A line drawn between the distal ends of the articular surface of the radius.
- The axial plane of radius: Represented by a line that is perpendicular to the diaphysis of the radius.
Sometimes, the diaphysis of the radius is hard to distinguish from the ulna, and a line between them may be used instead.[2]
Although this is the standard definition of dorsal or volar tilt, the parameter can be interpreted by clinicians as being in relation to the normal anatomical position of the articular surface of radius (which normally has a volar tilt of 11° to 12°), and should therefore be specified as shown in report.
Other important features
Check if present or absent:
Ulnar variance: Normally between -4 mm (ulna shorter than radius) and +2 mm (ulna longer than radius).[3]
Radial inclination.[3]
Radial inclination (also called radial angulation) is the angle measured between:[4][5]
- A line drawn between the distal ends of the articular surface of the radius on an AP view of the wrist.
- A line that is perpendicular to the diaphysis of the radius.
Radial inclination is normally 21-25°.[6]
Other important measures
- Displacemen in other directions
- Comminuted fracture, particularly if it has intra-articular involvement
- Other skeletal fractures, commonly a loose ulnar styloid process.
Report
- If volar or dorsal tilt:
- The degree thereof
- That is it in comparison to the axial plane of radius (to avoid mixup with being in relation to the normal anatomical position)
- Other abnormal important features, if present
- See also: General notes on reporting
See also
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ Piva Neto, Antonio; Lhamby, Fabio Colla (2011). "Fixação das fraturas da extremidade distal do rádio pela técnica de kapandji modificada: avaliação dos resultados radiológicos ". Revista Brasileira de Ortopedia 46 (4): 368–373. doi:. ISSN 0102-3616.
- ↑ Dr Paresh K Desai. Colles fracture. Radiopedia. Retrieved on 2016-12-18.
- ↑ 3.0 3.1 Beumer, Annechien; Adlercreutz, Catharina; Lindau, Tommy R (2013). "Early prognostic factors in distal radius fractures in a younger than osteoporotic age group: a multivariate analysis of trauma radiographs ". BMC Musculoskeletal Disorders 14 (1). doi:. ISSN 1471-2474.
- ↑ Jack A Porrino, Jr (2015-10-20). Distal Radial Fracture Imaging. Medscape. Retrieved on 2016-12-18.
- ↑ Pankaj Kumar Mishra; Manoj Nagar; Suresh Chandra Gaur; Anuj Gupta (2016). "Morphometry of distal end radius in the Indian population: A radiological study ". Indian Journal of Orthopaedics 50 (6). Archived from the original. .
- ↑ Page 783 in: Joshua Broder (2011). Diagnostic Imaging for the Emergency Physician . Elsevier Health Sciences. ISBN 9781437735871.
